The pharmacodynamics of dexmedetomidine in elderly cardiac patients undergoing analgosedation in the ICU
AbstractAim. This study aimed to evaluate the pharmacodynamics of dexmedetomidine in elderly cardiac patients.Material and Methods. Twelve patients of 60 years or older and need for analgesia after surgery or as a result of critical health conditions were included into our study. Dexmedetomidine was administered intravenously as a continuous infusion without the initial dose. At the beginning the infusion was started at the rate of 0.7 µg/kg/h and then it was continued in the range of 0.17–1.39 µg/kg/h according to desired level of sedation. Information about heart rate, systolic, diastolic and mean arterial blood pressure, bispectral index and cardiac index were collected a few minutes before, during and in 12 hours after infusion of dexmedetomidine.Results. The hemodynamic data as well as BIS level were collected from 12 patients. The duration of dexmedetomidine infusion was less than 9 hours. For each patient the reduction in blood pressure and heart rate compared to the value before dexmedetomidine infusion was observed. We did not observe bradycardia in any patient. Appropriate sedation level was achieved using only dexmedetomidine and ranged from 60 to 80. In only 2 cases it was necessary to give a single dose of another sedative.Conclusions. To conclude, in the patients’ population involved in the study, which included older cardiac patients dexmedetomidne has been shown as a sedative agent which enabled to achieve desire level of sedation in the recommended ranges without episodes of bradycardia, however hypotension events were noted.
Peterson C, Hall M. Pro: Dexmedetomidine Sedation Should Be Used Routinely for All Post-Cardiac Surgical Patients in the Intensive Care Unit. Journal of Cardiothoracic and Vascular Anesthesia. 2016 Oct;30(5):1419–1421.
[Internet] European Medicines Agency. Assesment Report Dexdor. 2011. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_report/human/002268/WC500115632.pdf [cited 1.12.2017].
Karol M, Maze M. Pharmacokinetics and interaction pharmacodynamics of dexmedetomidine in humans. Bailliere's Clinical Anaesthesiology. 2000 June;14(2):261–269.
Hashemian M, Ahmadinejad M, Mohaerani SA, Mirkheshti A. Impact of dexmedetomidine on hemodynamic Changes during and after coronary artery bypass grafting. Annals of Cardiac Anaesthesia. 2017 Apr-Jun;20(2):152–157.
Akin A, Bayram A, Esmaoglu A, Tosun Z, Aksu R, Altuntas R, Boyaci A. Dexmedetomidine vs. midazolam for premedication of pediatric patients undergoing anesthesia. Paediatr Anaesth. 2012 Sep;22:871–876.
Wiczling P, Bartkowska-Śniatkowska A, Szerkus O et al. The pharmacokinetics of dexmedetomidine during long-term infusion in critically ill pediatric patients. A Bayesian approach with informative priors. J Pharmacokinet Pharmacodyn. 2016;43:315–324.
Xu B, Zhou D, Ren L, Shulman S, Zhang X, Xiong M. Pharmacokinetic and pharmacodynamics of intravenous dexmedetomidine in morbidly obese patients undergoing laparoscopic surgery. J Anesth. 2017 Dec;31:813–820.
Afonso J, Reis F. Dexmedetomidine: current role in anesthesia. Rev Bras Anesthesiol. 2012 Jan-Feb;62:118–133.
Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet. 2017 Aug;56:893–913.
Bienert A, Płotek W, Wiczling P, Warzybok J, Borowska K, Buda K, Kulińska K, Billert H, Kaliszan R, Grześkowiak E. The in?uence of age and dosage on the pharmacodynamics of dexmedetomidine in rabbits. JMS. 2014;83:108–115.
Gerlach AT, Dasta JF. Dexmedetomidine: an updated review. Ann Pharmacother. 2007 Feb;41:245–252.
Huang Z, Chen Y, Yang Z, Liu J. Dexmedetomidine Versus Midazolam for the sedation of patients with non-invasive ventilation failure. Intern Med. 2012 Sep;51(17):2299–2305.
Duarte LT, Saraiva RÂ. When the bispectral Index (Bis) can give false results. Rev Bras Anestesiol. 2009 Mar-Apr;59(1):99–109.
Coleman RM, Tousignant-Laflamme Y, Ouellet P, Parenteau-Goudreault É, Cogan J, Bourgault P. The use of the bispectral index in the detection of pain in mechanically ventilated adults in the intensive care unit: A review of the literature. Pain Res Manag. 2015 Feb;20(1):33–7.
Carlsson M, Andersson R, Bloch KM, Steding-Ehrenborg K, Mosén H, Stahlberg F et al. Cardiac output and cardiac index measured with cardiovascular magnetic resonance in healthy subjects, elite athletes and patients with congestive heart failure. J Cardiovasc Magn Reson. 2012 Jul;14(1):51–57.
Cattermole GN, Leung PYM, Ho GYL, Lau PWS, Chan CPY, Chan SSW et al. The normal ranges of cardiovascular parameters measured using the ultrasonic cardiac output monitor. Physiol Rep. 2017 Mar;5(6):e13195.
Arora D, Mehta Y. Recent trends on hemodynamic monitoring in cardiac surgery. Ann Card Anaesth. 2016 Oct-Dec;19(4):580–583.
Hui C, Cardinale M, Yegneswaran B. Significant Bradycardia in Critically Ill Patients Receiving Dexmedetomidine and Fentanyl. Case Rep Crit Care. 2017;2017: 4504207.
Buyukkaya E, Erayman A, Karakas E, Bugra Nacar A, Kurt M, Buyukkaya S et al. Relation of red cell distribution width with dipper and non-dipper hypertension. Med Glas (Zenica). 2016 Aug;13(2):75–81.
Dutta S, Lal R, Karol MD, Cohen T, Ebert T. Influence of cardiac output on dexmedetomidine pharmacokinetics. J Pharm Sci. 2000 Apr;89(4):519–27..